Monday, March 14, 2005

An Interesting Case

A few weeks ago a man brought a cat in to see me. The poor thing had been hit by a car 3 years ago, and broken his jaw in several places. The vet in Houston who tried to fix it hadn't done a very good job. The poor cat was left with a terrible malocclusion, with his lower canine teeth/fangs sitting completely lateral to his upper fangs. "That's the best the vet said he could do," the owner said, "He can still eat." Apparently -- the cat weighs 15 pounds.

He had developed a large swelling below his chin that was obviously infected. I put him on antibiotics and scheduled him to come back for anesthesia and Xrays. I wasn't sure what I'd find.

With one Xray, it was pretty obvious. This Xray shows the cat's lower jaw in profile, as if he is looking to your right. The previous vet had placed a cerclage wire around his mandible to stabilize a symphyseal fracture (on the midline of his jaw). That is a perfectly acceptable repair; I've done it myself. However, after about 6 weeks, you are supposed to remove the wire. Instead, after 3 years, the cat had made a HUGE granuloma around the wire, both losing bone next to the wire, and laying down new bone around the reactionary tissue. The twisted part of the wire originally would have been outside the skin at the bottom of the cat's chin, but now it was buried in tissue. The top part was above the gingiva in the oral cavity, wicking bacterial pathogens down into his jaw. I removed the wire and reduced the excessive tissue, to give him a more normal profile.

Unfortunately, there was also a fracture of the ramus of the mandible, the side of the jaw near the TMJ joint, that the previous vet ignored. That was the cause of the malocclusion. I called the local vet dentist and a surgeon, and both agreed that after 3 years of trying to heal this old fracture, a successful repair at this time was unlikely.

When I spoke to the owner, he said the previous vet never mentioned removing the cerclage wire. At least we have removed the offending object, and the cat can go back to his life of eating sideways. He must be good at it, at 15 pounds!

Hi Jennifer! I searched your blog site high and low for a way to contact you...can you send me your e-mail address! I wanted to send you a note. Thanks for coming over today, it was fun! Sorry this is not related to this blog article...gee, is this rude blog ettiquette or what?! Amy (write to me at amyadams@austin.rr.com please)